Melissa's mom remembers how obsessed Melissa became about dieting, which made her visits home very stressful. "She would announce to us all that she was only going to take a few bites of a sandwich because then she could enjoy her dessert later," recalls Sue.
Eating disorders are characterized by abnormal behaviors that prevent people from having a healthy relationship with food. The types of disorders reach far beyond the commonly known conditions like anorexia nervosa, when someone starves and depletes the body of necessary nutrition; bulimia nervosa, or bingeing and purging; and binge-eating disorder which refers to people who eat thousands of calories at one time.
Outsiders often assume people with eating disorders have a choice whether to eat properly. But experts say eating disorders disrupt logic and cause cognitive distortions or abnormal thinking patterns. For example, "all-or-nothing thinking" is a cognitive distortion, which sometimes leads disordered eaters to think, "if I gain weight, I will be a worthless person." When a fetus enters the equation, the impaired thinking prevents mothers from rationalizing what they need to do for the health of their unborn child.
For someone like Melissa, disordered eating helps classify the extreme behaviors and psychological side effects of a weight-loss obsession, without excessive starvation, purging or obesity. Even though Melissa does not have anorexia, bulimia, or binge-eating disorder, her particular kind of uncategorized disorder still presents a serious problem. For women like Melissa, pregnancy can either push them further into the disease, or offer them a nine-month respite.
At the Melrose Institute in St. Louis Park, Minn., Dr. Paula Deakins, a specialist for pregnant women with eating disorders, says they will give preferential treatment to their pregnant patients who are actively engaged in an eating disorder. "We put them in the hospital a lot more quickly than we would with a regular patient," Deakins says.
But she cannot force treatment on her patients and worries about the struggling women who refuse to come forward. "The message we need to get to the public is that it is the obstetrician who needs to send them to us," Deakins says.
According to Deakins, 60 to 70 percent of eating-disorder patients experience remission during pregnancy. While the actual pregnancy can aggravate an eating disorder, the postpartum period can compound its intensity.
A woman's body is already stressed after giving birth. Extreme starvation worsens the situation, making it impossible for a new mother to feed her child when lactation stops because of dehydration and malnutrition.
Pregnant women need certain nutrients, but readjusting the diet of an eating-disorder patient to consume those nutrients can be problematic.
"It's never just the calories with me," says Julie Mowery, a Registered Dietician at the Melrose Institute for 15 years. Nutrients are critical during pregnancy because the body is already comprised if the mother has been suffering from an eating disorder. Mowery encourages expecting mothers to have enough calcium, folate and protein.
One of the hardest obstacles for pregnant women with eating disorders, Mowery says, is ingesting enough fat. The fear of gaining weight leads pregnant women to cut fatty foods, but a developing fetus needs fatty acids.